Necrotizing fasciitis: a challenging diagnosis

Hefny, Ashraf F.; Eid, Hani O.; Al-Hussona, Mudher; Idris, Kamal; Abu‐Zidan, Fikri M.

doi:10.1097/01.mej.0000228447.48276.7b

Cited by 49 publications

(37 citation statements)

References 10 publications

(22 reference statements)

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“…(12) reported A. baumannii as a monomicrobial cause of necrotizing fasciitis in 2 of 87 cases. However, the same study found a single pathogen as the causative agent of necrotizing fasciitis in 67.8% of the cases studied, a finding that is inconsistent with those of most other studies, which have reported a polymicrobial cause in the majority of cases (6,8,10,11,19). Liu et al acknowledged that their high rate of monomicrobial isolation might have been due to "relatively unsophisticated techniques for collection, transfer, or culture of anaerobic specimens," but they did not explain this further (12).…”

Section: Not Performed յ2mentioning

confidence: 68%

“…Most studies find necrotizing fasciitis to be polymicrobial in approximately 70% of cases, with the most common microorganisms identified as being group A and B streptococci, the staphylococci, members of the family Enterobacteriaceae, and Pseudomonas aeruginosa (6,8,10,11,19). Necrotizing fasciitis is therefore, no longer known as "acute streptococcal gangrene," the term originally used to describe the syndrome by Meleney in 1924 (14).…”

Section: Not Performed յ2mentioning

confidence: 99%

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Two Cases of Necrotizing Fasciitis Due toAcinetobacter baumannii

et al. 2009

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Necrotizing fasciitis has conventionally been associated with the streptococci, and when it is caused by other organisms, it is most often the result of a polymicrobial infection. We report on two cases of fatal monomicrobial necrotizing fasciitis due to Acinetobacter baumannii, an unusual finding that may be an indication of enhanced virulence of the organism. CASE REPORTS Case 1. Patient X was a 21-year-old male with multiple medical problems, including end-stage renal disease secondary to systemic lupus erythematosus, thrombotic thrombocytopenic purpura, and mesenteric vasculitis. The patient had been treated with prolonged courses of systemic corticosteroids and intermittently with rituximab and had undergone multiple courses of treatment consisting of plasmapheresis, blood transfusions, and hemodialysis. In August 2007, he was admitted to the hospital for pulmonary edema and bright red blood from the rectum. At that time, blood cultures grew vancomycinresistant Enterococcus faecium and Candida albicans. He was treated with daptomycin and fluconazole, and all blood cultures subsequently became negative. Days later, he tested positive for Clostridium difficile-associated colitis; therefore, metronidazole was added to his antibiotic regimen.Despite embolization of the vessels of the terminal ileum, the patient continued to experience gastrointestinal bleeding. He therefore underwent an exploratory laparotomy, ileocecal resection, and ileostomy 3 weeks after admission. He appeared to be recovering until 5 days later, when he developed bacteremia caused by the gram-negative organisms Klebsiella pneumoniae and Citrobacter freundii, for which he was treated with imipenem and was continued on metronidazole.Two weeks after the ileocecectomy, at approximately 2 a.m., the patient noted pain along his left flank and thigh. Physical examination revealed faint erythema and tenderness. By 11 a.m. of the same day, there were marked increases in the levels of erythema, edema, and pain. The erythema extended beyond a marked line by greater than 2 cm in 1 h. It extended from flank to flank across the patient's back and thighs bilaterally. Bullae appeared on the skin over a similar distribution. An incision was performed at the bedside, and a frozen section revealed inflamed and necrotic fibroconnective tissue and muscle, with quantitative biopsy specimens revealing Ͼ100,000 gram-negative rods. The patient gave consent for and underwent an emergent debridement in the operating room for suspected necrotizing fasciitis. Amikacin, vancomycin, and clindamycin were empirically added to his existing antibiotic regimen of imipenem and metronidazole, pending culture and susceptibility testing results.

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Section: Not Performed յ2mentioning

confidence: 68%

Section: Not Performed յ2mentioning

confidence: 99%

Two Cases of Necrotizing Fasciitis Due toAcinetobacter baumannii

et al. 2009

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“…The disease progresses faster in patients with diabetes, chronic kidney insuf iciency, immunocompromising diseases, patients with surgical traumas and patients undergoing radiation therapy. The diagnosis is based on clinical signs that initially can be hard to notice, that's why the diagnosis is set in the late stages of the disease, which results in comparatively high mortality [7][8][9][10][11]. In this case one of the major factors that had a role in the spreading of the infection was the infected cyst that was treated with antibiotics.…”

Section: Discussionmentioning

confidence: 99%

Untitled

2017

J Oral Health Craniofac Sci

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Necrotizing fasciitis is a quickly progressing soft tissue infection that can be described with diffuse necrosis of subcutaneous tissue and superfi cial fascia. The cause of this can be infectious process of odontogenic origin, most commonly caused by mixed gram+ and gram-, aerobic and anaerobic microorganisms that are found in patients that are predisposed to infections. In a case of undiagnosed illness, there is a possibility of life threatening complications. This case analysis introduces the diagnostic criteria of the disease and treatment plan, encouraging doctors to devote more attention to prevention of infections.

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“…2 This condition is a significant surgical emergency; the diagnosis is often elusive in the early stages and should be considered in all cases of severe cellulitis, especially those resistant to antimicrobial agents. 3,4 The delay resulting from the diagnostic challenge of necrotizing fasciitis inevitably leads to increased mortality. 5 Implantation of a PPM is the treatment of choice for bradyarrhythmias.…”

Section: Discussionmentioning

confidence: 99%

Necrotizing fasciitis secondary to the insertion of a cardiac pacemaker

et al. 2012

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We present, to our knowledge, the first reported case of necrotizing fasciitis following insertion of a cardiac permanent pacemaker (PPM).A 91-year-old gentleman was admitted with septic shock under the medical team. He had had a cardiac PPM inserted 10 days prior for complete heart block. He was initially treated by the GP for a postoperative superficial infection with a course of oral antibiotics at home but over the next few days he became systemically unwell. Preadmission, this patient was independent, living with his wife and had no other significant past medical history apart from the heart block.On admission he had suffered a ventricular tachycardia-related cardiac arrest and had been successfully resuscitated. He was subsequently managed in the coronary care unit (CCU) with a diagnosis of systemic sepsis from an infected pacemaker.While in CCU his condition deteriorated and he developed acute renal failure. It was noted that the cellulitis was becoming increasingly widespread around the pacemaker site, and was not responding to the intravenous antibiotics. There was an extremely high suspicion of necrotizing fasciitis, and the plastic surgeons were contacted for a review. The same day, he was expeditiously taken to theatre by the plastic surgical team.Perioperative findings included the presence of murky fluid, oedema of the subcutaneous tissue and necrotic muscle around the pacemaker. This gentleman then underwent a radical debridement of the infected tissues. The infected pacemaker was removed and the patient temporarily externally paced.Microbiology revealed the causative organisms to be Staphylococcus capitis, Streptococcus salivarius and Staphlococcus aureus. The histology from the samples gathered at the time of the procedure was consistent with a diagnosis of necrotizing fasciitis.Following treatment in the intensive care unit, the open chest wound was closed with a split thickness skin graft, five days post-debridement. He had re-implantation of a new PPM on the contralateral (right) side two days later.

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Necrotizing fasciitis: a challenging diagnosis

Cited by 49 publications

References 10 publications

Two Cases of Necrotizing Fasciitis Due toAcinetobacter baumannii

Two Cases of Necrotizing Fasciitis Due toAcinetobacter baumannii

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Necrotizing fasciitis secondary to the insertion of a cardiac pacemaker

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